Health History

Below are the forms that we need to help us assess your overall health and wellness. Please fully complete them and bring them with you on your visit to the office. Your answers will help us determine if chiropractic can help you. If you need help with this form, please do not hesitate to call us at (613) 256-2813.

Our goals are to first address the issues that brought you to this office and second to offer you the opportunity of improved health, wellness and quality of life in the future. On a daily basis we experience physical, biochemical, and emotional stresses that can accumulate and result in serious loss of health potential. Most times the effects are gradual and may not even be felt until they become serious or cause pain. Answering the following questions will give us a profile of specific stresses, past and present that you face and allow us to better assess the challenges to your health potential.

We look forward to meeting you,
Dr Jaye Carlson and Dr Mark Herman


Children (0-12 Years)

Yes, we check and treat children!
 Download & Print Form


Health History and Future

This lets us know what’s happened, but perhaps more important, where do you want to take your health?
 Download & Print Form


Free AdobeReader®

Each form is a PDF document file.  If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.

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Women's Health Issues
Children's Health Issues
Stress Management

Dr. Mark Asks some important questions of interest to Almonte residents - Chiropractor Almonte Dr. Mark Asks...

Would you rather feel good or be healthy?
Ask most people in Almonte and they want to feel good. Careful! Would you take medicine that makes you feel good, rather than vomit to expel improperly prepared food? Every chiropractic practice member knows that you can't measure your health by how you feel. True health is when your body works as it should.
Why do so many drugs require a prescription?
Because they can be dangerous? I chose a chiropractic career specifically because it avoids artificial means of pain relief. Our Almonte chiropractic practice attracts health-conscious families that prefer a safe and natural solution. Ready to get started? Call our office today.